A survey of antimicrobial prescribing and dispensing practices in rural Bangladesh.

This study was undertaken to determine the patterns of antimicrobial prescription by 64 Rural Medical Practitioners (RMPs) from Bangladesh. The antimicrobial dispensing procedures followed by the local retail drug sellers along with the purchasing capacities of the patients was also assessed. All antimicrobial agents were prescribed mainly on the patient's complaints, and all available antibiotics were prescribed in inappropriate doses and duration. In most cases, the RMPs initiated treatment with a parenteral form of antibiotic, and a different oral antibiotic usually followed. Parenteral streptomycin was used most frequently in short inadequate courses. Almost half of the antibiotics were sold without any prescriptions, and even ordinary people without any knowledge of medicine asked the drug seller for specific antibiotics. This unregulated prescribing and dispensing practice has the potential risk for the development and spread of antimicrobial resistance on a global scale.

Molecular analysis of multi-drug resistant Salmonella typhi from urban paediatric population of Bangladesh.

The prevalence and genetic basis of resistance of multi-drug resistant (MDR) S typhi strains from an urban paediatric population was determined. Blood cultures performed on 109 cases of suspected typhoid fever yielded 30(27.5%) S typhi isolates. Of these, 20(67%) S typhi isolates were resistant to the common antimicrobials used in Bangladesh, eg, chloramphenicol, ampicillin, cotrimoxazole, streptomycin and tetracycline, while 6(20%) isolates were resistant only to streptomycin. However, all the isolates were sensitive to fluquinolones and cephalosporins. Molecular analysis demonstrated that all MDR strains possessed a single large transferable 98 MDal plasmid. On conjugation, chloramphenicol, ampicillin and cotrimoxazole resistance was transferred from MDR strains to E coli K-12. Restriction endonuclease analysis of plasmid DNA showed similar digest profiles of all 5 selected donors and their transconjugants. This trend of increasing resistant strains of S typhi, especially by the transferable plasmid is of major public health concern.

Acute bacterial meningitis in Malawi

Acute bacterial meningitis [ABM] is a life threatening disease which often occurs after colonization of the nasopharyngeal mucosa by pathogenic bacteria. Although other organisms do not occur infrequently; Neisseria meningitidis; Haemophilus influenzae; and Streptococcus pneumoniae are responsible for more than 90 percent of the cases outside the neonatal period. The epidemiology of each of these bacteria differs in geographical distribution; incidence; mortality rates; age of the population affected and susceptibility to antibiotics and these factors are discussed in the article

Cryptosporidiosis in children in Malawi

Cryptosporidium accounted for 9 (4.3 percent) of cases of gastroenteritis among 208 children with diarrhea attending an Under Five out-patient clinic at Queen Elizabeth Central Hospital; but was not excreted by 96 children without diarrhea. It was second only to rotavirus (41.7 percent of cases) in causing gastroenteritis. Breast feeding apparently did not provide complete protection against cryptosporidiosis. In a prospective survey the safarin methylene blue and flourescent auramine phenol staining techniques had the same sensitivity (85 percent) and specificity (100 percent)

Bacterial meningitis in KCH; Lilongwe

A study of epidemiological patterns of bacterial meningitis in Lilongwe using laboratory records from the period 1983-1986 and clinical records of patients admitted to Kamuzu Central Hospital